We Asked the Experts: The WHO Surgical Safety Checklist and the COVID-19 Pandemic: Recommendations for Content and Implementation Adaptations.

BACKGROUND: As surgical systems are forced to adapt and respond to new challenges, so should the patient safety tools within those systems. We sought to determine how the WHO SSC might best be adapted during the COVID-19 pandemic. METHODS: 18 Panelists from five continents and multiple clinical specialties participated in a three-round modified Delphi technique to identify potential recommendations, assess agreement with proposed recommendations and address items not meeting consensus. RESULTS: From an initial 29 recommendations identified in the first round, 12 were identified for inclusion in the second round. After discussion of recommendations without consensus for inclusion or exclusion, four additional recommendations were added for an eventual 16 recommendations. Nine of these recommendations were related to checklist content, while seven recommendations were related to implementation. CONCLUSIONS: This multinational panel has identified 16 recommendations for sites looking to use the surgical safety checklist during the COVID-19 pandemic. These recommendations provide an example of how the SSC can adapt to meet urgent and emerging needs of surgical systems by targeting important processes and encouraging critical discussions.

Clinical Issues-October 2017.

• Bowel isolation technique in minimally invasive surgery Key words: minimally invasive surgery, bowel isolation technique, bowel resection. • Covering hair that has escaped a surgical cap Key words: OR attire, head covering, sterile technique. • Surgical head coverings Key words: skull caps, bouffant caps, quality control, quality initiative. • Use of ear loop masks in the OR Key words: surgical mask, OR attire. • Staffing in the hybrid OR Key words: RN circulator, hybrid OR, staffing.

Clinical Issues-May 2017.

Standardized room layouts for minimally invasive surgery in a hybrid OR Key words: room setup, equipment placement, no-fly zone, collision. Measuring fluids during minimally invasive surgery procedures Key words: fluid distention media, hyponatremia, isotonic solution, hypotonic solution. Magnetic resonance imaging safety zones Key words: MRI, safety, zones, screening. Robot-assisted surgery competencies Key words: robotics, credentialing, competency verification.

Guideline Implementation: Minimally Invasive Surgery, Part 2-Hybrid ORs.

Performing both surgical and imaging procedures in a hybrid OR can increase efficiency by reducing the number of patient transfers between departments and the number of patient hand overs between personnel. A hybrid OR is, however, a complex environment that requires integrating the knowledge and skills of personnel from multiple disciplines to create a successful workflow. When magnetic resonance imaging (MRI) equipment is installed in the hybrid OR, additional precautions are required to help ensure the environment is safe for patients and personnel. AORN's updated "Guideline for minimally invasive surgery" provides guidance for personnel designing and working in hybrid ORs and MRI hybrid ORs. This article focuses on key points of the guideline that address hybrid OR configuration, hybrid OR staffing, and mitigating risks associated with intraoperative MRI. Perioperative RNs should review the complete guideline for additional information and for guidance when writing and updating policies and procedures.